Healthcare Provider Details

I. General information

NPI: 1497979173
Provider Name (Legal Business Name): LISA MARIE HOUCHIN P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 VIRGINIA ST
MERRILLVILLE IN
46410-6231
US

IV. Provider business mailing address

12363 RANDOLPH CT
CROWN POINT IN
46307-8095
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-9009
  • Fax:
Mailing address:
  • Phone: 219-662-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002691A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: